In the past, certain surgical procedures required relatively large incisions to be made into the body in order to gain visual and instrumental access to a surgical site deep within the body. This incision provides a passageway by which various instruments operate upon the patient's anatomy. At times, it is necessary for the passageway to accommodate several instruments simultaneously, including but not limited to ancillary means for illuminating the surgical site or chilling the area to protect tissue and cellular integrity while still maintaining area for instruments performing the specific procedure.
By way of example, surgical procedures on posterior spine elements may have required relatively large incisions to be made to effectively operate on the spine elements. These large incisions are generally undesirable as they may result in increased damage to muscle tissue including, but not limited to, local denervation atrophy, a loss of support and stability creating pain, localized ischemia (the deprivation of oxygen), and potential scarring.
More recently, however, many surgical procedures are conducted using minimally invasive techniques that seek to minimize some of the undesirable aspects of past procedures. Such techniques typically involve splitting the muscle tissue, as opposed to cutting the muscle tissue, which in turn causes less damage to the muscle, increases the recovery times, and reduces patient discomfort.
Once a path to the surgical site is established, an access system, such as a surgical portal or retractor, may be inserted through the incision to provide the necessary retraction so as to establish an unencumbered path to the surgical site. Thus, the access port effectively defines a working bore or space and provides visual and instrument access to the surgical site in a minimally invasive manner. Additionally, studies have shown that localized hypothermia of the surgical site increases the survival rate of the cellular tissue by decreasing the tissue's need for nutrients and by inhibiting the ischemic cascade, with the longer-term effects of reducing the inflammatory response and cellular necrosis typically caused by the incision through the tissue and localized pressure on the tissue by the access system.
Although several minimally invasive access systems and techniques have been developed, there remains room for improvement. In particular, there is a need for an improved access system having an integrated ability to chill the surgical site to a hypothermic state to decrease the occurrence of cellular necrosis because of the increased pressure on tissue commonly found with the use of retractor systems in minimally invasive surgery. Additionally, there is a need for a method of illuminating a surgical site that addresses drawbacks of current systems and methods.